Prandin (repaglinide) is a rapid-acting meglitinide analog oral antihyperglycemic agent indicated for the management of hyperglycemia in adults with type 2 diabetes mellitus, often in combination with metformin or as monotherapy when metformin is contraindicated or not tolerated. It functions by stimulating insulin secretion from the pancreatic beta cells in a glucose-dependent manner, making it particularly effective for controlling the sharp rises in blood glucose that occur following meals. This medication is designed to be taken with main meals, offering flexible dosing to accommodate variable meal patterns and schedules. Prandin provides a targeted therapeutic approach for patients requiring postprandial glycemic control without a prolonged duration of action.

Features

• Active ingredient: Repaglinide (0.5 mg, 1 mg, or 2 mg tablets)
• Pharmacologic class: Meglitinide analog
• Rapid onset of action: begins working within 30 minutes of administration
• Short duration of effect: approximately 3–4 hours
• Administered orally, immediately before main meals (up to 4 times daily if needed)
• Available as scored tablets for dose titration

Benefits

• Effectively lowers postprandial blood glucose excursions by stimulating meal-time insulin secretion
• Reduces HbA1c levels, helping patients achieve glycemic targets
• Flexible dosing schedule allows adaptation to irregular meal patterns or skipped meals
• Lower risk of prolonged hypoglycemia compared to some longer-acting secretagogues due to its short half-life
• Can be used as an adjunct to metformin for enhanced glycemic control when monotherapy is insufficient
• Suitable for patients with renal impairment (with caution and dose adjustment), unlike some other antidiabetic agents

Common use

Prandin is commonly prescribed for the management of type 2 diabetes mellitus in adults, particularly in patients who experience significant postprandial hyperglycemia. It is often used when lifestyle modifications—such as diet and exercise—alone are insufficient to achieve glycemic control. It may be prescribed as monotherapy or in combination with other antihyperglycemic agents like metformin, especially when a synergistic effect on insulin secretion and insulin sensitivity is desired. It is not indicated for type 1 diabetes or diabetic ketoacidosis.

Dosage and direction

The recommended starting dose for Prandin is 0.5 mg taken orally within 30 minutes before each main meal. For patients previously treated with other oral hypoglycemic agents, the starting dose may be 1 mg or 2 mg before meals. Doses can be titrated at weekly intervals based on blood glucose monitoring, with a maximum recommended single dose of 4 mg per meal and a maximum total daily dose of 16 mg. The medication should be taken immediately before a meal; if a meal is skipped, the corresponding dose should also be omitted to reduce the risk of hypoglycemia.

Precautions

Patients should be advised to monitor blood glucose regularly, especially during dose titration. Prandin may cause hypoglycemia; caution is advised when driving, operating machinery, or engaging in hazardous activities. Use with caution in patients with hepatic impairment, as repaglinide is extensively metabolized in the liver. Elderly patients and those with adrenal or pituitary insufficiency may be more susceptible to hypoglycemia. It is important to maintain a regular meal schedule to synchronize dosing and caloric intake.

Contraindications

Prandin is contraindicated in patients with known hypersensitivity to repaglinide or any excipients in the formulation. It is also contraindicated in patients with type 1 diabetes, diabetic ketoacidosis, or severe renal impairment (creatinine clearance <30 mL/min). Concomitant use with gemfibrozil is contraindicated due to a significant interaction that increases repaglinide exposure and hypoglycemia risk.

Possible side effects

Common side effects include hypoglycemia (which may manifest as dizziness, sweating, tremor, headache, or confusion), upper respiratory tract infection, and diarrhea. Less frequently, patients may experience arthralgia, back pain, or allergic skin reactions. Severe hypoglycemia, although rare, requires immediate intervention. Elevated liver enzymes have been reported in some patients.

Drug interaction

Prandin is primarily metabolized by CYP2C8 and CYP3A4 enzymes. Concomitant use with CYP2C8 inhibitors (e.g., gemfibrozil—contraindicated; trimethoprim) or CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin) may increase repaglinide levels and hypoglycemia risk. Inducers of these enzymes (e.g., rifampin, barbiturates, carbamazepine) may reduce its efficacy. Beta-blockers, clonidine, or MAO inhibitors may mask hypoglycemia symptoms. NSAIDs, salicylates, or sulfonamides may enhance hypoglycemic effects.

Missed dose

If a dose is missed and it is within 30 minutes before the meal, it may still be taken. If the meal has already started or been completed, the missed dose should be omitted. Do not double the dose to make up for a missed one, as this increases hypoglycemia risk.

Overdose

Overdose of Prandin may lead to severe hypoglycemia. Symptoms include confusion, palpitations, sweating, and loss of consciousness. Management includes immediate intake of oral carbohydrates (if conscious) or administration of intravenous glucose or glucagon (if unconscious). Close monitoring of blood glucose and symptomatic support are essential; hospitalization may be required in severe cases.

Storage

Store Prandin tablets at room temperature (15–30°C or 59–86°F) in a tightly closed container, protected from light and moisture. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for personalized recommendations and before starting or altering any medication regimen. Individual patient responses may vary.

Reviews

Clinical studies and post-marketing surveillance indicate that Prandin is effective in reducing postprandial glucose and HbA1c levels, with a favorable safety profile when used as directed. Many patients appreciate the flexibility it offers with meal-time dosing. Some reports note the need for careful meal planning to avoid hypoglycemia. Overall, it is considered a valuable option for targeted postprandial glycemic management in type 2 diabetes.